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California’s Water Crisis

Even in a state with the sixth largest economy in the world, there are as many as one million Californians exposed to unsafe drinking water.1 According to the California State Water Resources Control Board, as of 2017, more than 300 public water systems in California were documented to be out of compliance with the Environmental Protection Agency’s drinking water regulations. For a water system to be deemed “out of compliance,” it must exceed the maximum threshold for contaminants, fail to use proper treatment techniques or fail to monitor and/or report whether the water is safe for human consumption.

This problem most affects the farm-working communities located in the central valley of California, but also extends to parts of the central coast and southern California.2 The table below is a visual representation of FY2013-2014 data collected by the Safe Drinking Water Information System (SDWIS) as reported to the EPA by states.3

The third column, “percentage of population in violation,” is an estimate of the percentage of the county population impacted by any health-based drinking water violations throughout the year. These numbers may vary, because water systems have many partnerships with different jurisdictions, however, they give an idea of the number of affected counties and approximate number of people affected. It is important to note, this data is also limited to public water system information. Any private wells used to supply drinking water were not included.

There are several contributing factors to unhealthy, contaminated water. One that especially impacts the vulnerable farmland community involves their fertilizer and cow manure. Both are rich in nitrate, which can sink into the groundwater and inadvertently be pumped up through wells into home plumbing. In excess, nitrate is known to cause miscarriages, stillbirths, premature births, sudden infant death syndrome, diarrhea, cancer and “blue baby syndrome,” which is indicated by a shortness of breath and skin-darkening. Another contaminant often found in the water supply around farmland is arsenic. Arsenic is naturally found in the ground but is often augmented by chemical fertilizers. Once again, as the poison sinks further into the groundwater, it it will often show up in home tap water. An overload of arsenic can cause skin damage, circulatory trouble and cancer. All health outcomes, ranging from the benign to the most severe conditions, are byproducts of consuming unsafe water.

What makes this situation even more dire is that our most common defense against “dirty” water, boiling, may actually make matters worse. In the case of nitrate and arsenic, for example, the Centers for Disease Control and Prevention (CDC) warn that heating or boiling water will not remove either contaminant and since the heat will cause water to evaporate, it may actually increase the amount of contaminant.4

Unhealthy drinking water habits also occur because of dried up wells. According to state data from January of this year, 3,511 counties, including Tulare, Madera and Stanislaus, reported having dried-up wells.5 Without a reliable water supply, members of these communities are forced to budget for bottled water for consumption and may have to resort to bathing in portable, public showers often set up in a church parking lots. Some families reported having to spend about 10 percent of the household income on bottled water6 - a significant drain on family finances, especially if they belong to low-income communities.

As these problems are brought to light, much has been done to help remedy the situation. In 2012, Governor Jerry Brown signed the Human Right to Water Bill, making California the first state to legally recognize that every human being has a right to safe, clean, affordable and accessible water. There are also statewide efforts such as the Aqua4All campaign that has launched pilot programs to bring water fountains and water bottle filling stations to schools, parks and community centers; the need for which can be seen in the map below. Additionally, in June, SB 623 (Monning), the Safe and Affordable Drinking Water Fund, passed the Senate and is currently headed to the Assembly. This bill is intended to fill funding gaps that leave small and low-income communities unable to provide safe drinking water to their residents.

As a family physician, and especially as one who serves these affected communities, it is important keep aware of statewide efforts to disseminate clean water. Educational materials and videos to help inform the public are often available. Another source of concentrated information can come from medical toxicology educational conferences. The American College of Medical Toxicology, for example, hosts several of these throughout the year and country. In a world where more and more studies show that water pollution can be correlated to chronic diseases, it is important to stay ahead of the curve and educate not only yourselves but also your patient base.

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The California Academy of Family Physicians is the only organization solely dedicated to advancing the specialty of family medicine in the state. Since 1948, CAFP has championed the cause of family physicians and their patients.

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Note:The California Academy of Family Physicians cannot answer medical questions, give referrals to specific family physicians or endorse products. Visit the American Board of Family Medicine website to find a board-certified family physician in your area.